强化照顾者健康教育对脑外伤离院患者日常生活能力的影响

Effects of enhancing caregiver health education on activities of daily living of discharged patients with traumatic brain injury

目的：探讨对照顾者实施以日常生活能力为导向的延续性健康教育，对脑外伤（traumatic brain iniury．TBI）后肢体功能障碍离院患者日常生活能力（activities of daily living，ADL）的影响。方法：选取重庆某三甲医院神经外科2个同质化病区内的脑外伤后肢体功能障碍离院患者100例，按所住病区分组，A病区纳入对照组50例，B病区纳入干预组50例。对照组照顾者予以出院前1d及出院后1周时常规健康教育，干预组照顾者在对照组常规健康教育的基础上出院前2-3d予以日常生活能力为导向的健康教育并在出院后第1周、第3周及第5周电话健康教育，比较2组患者在出院2个月后日常生活能力改善情况，同时比较2组照顾者的日常生活态度及知识。结果：出院时干预组和对照组患者日常生活能力评分（modified Bahel index，MBI）为43．50±16．14及42．40±13．64，无统计学差异（P=-0．714），出院2月后干预组和对照组患者MBI为82．60±24．99及70．70±22．88，具有统计学意义（P=O．015）；2组照顾者日常生活态度及知识各维度得分在出院时无统计学差异（P〉0．05），出院2月时干预组照顾者日常生活态度及知识各维度得分均高于对照组，差异均有统计学意义（P〈0．05）。结论：加强以日常生活能力为导向的延续性照顾者健康教育。能改善照顾者日常生活态度及知识，提高脑外伤后肢体功能障碍离院患者的日常生活能力。

Objective：To explore the effect of enhancing caregiver health education on activities of daily living （ADL） of discharged traumatic brain injury patients with limb dysfunction. Methods ：Totally 100 discharged traumatic brain injury patients with limb dys- function were randomly divided into control group and intervention group according to their ward：50 patients from A ward in control group while 50 patients from B ward in intervention group. Caregivem in control group were given the routine health education 1 d before discharge and 1 week after diseharge;caregivers in intervention group received the routine health education and the ADL ori- ented health education 2-3 d before discharged as well as the telephone follow-up health education at the first week,the third week and the fifth week after discharge in addition. The modified Barthel index（MBI） of patients,the ADL attitudes and knowledge of caregivers between the two groups were compared two months later. Results： MBI of intervention group and control group was 43.50 ± 16.14 and 42.40 ±13.64 on the day before discharge,without significant differences（P=0.714）. MBI of intervention group and control group increased to 82.60 ±24.99 and 70.70 ±22.88 at 2 months after discharge,with statistically significant differences between two groups（P=-0.015）. There was no difference in scores of caregivers＇ attitudes and knowledge at discharge between two groups （P〉0.05）. The scores of caregivers＇ attitudes and knowledge was higher in intervention group than in control group 2 months after discharge（P〈 0.05）. Conclusion：The ADL oriented continuity caregiver health education can improve the daily living of discharged traumatic brain injury patients with limb dysfunction effectively,as well as caregivers＇ attitudes and knowledge of ADL.